Shoulder Impingement in Swimmers

What is “swimmer's shoulder”? The term describes shoulder pain in the competitive swimmer. It is an inflammatory condition caused by the impingement (rubbing or squeezing) of soft tissue against the coracoacromial arch.

Why is it called “swimmer’s shoulder”? Swimming is an unusual sport in that the shoulders and upper extremities are used for movement, while at the same time require above average shoulder flexibility and range of motion.  This is often associated with an undesirable increase in joint laxity. Also, the water provides a much greater resistance to movement than air. This combination of demands can lead to overuse injuries seen in the swimmer's shoulder, the most common of which is rotator cuff tendinitis. The repetitive overhead arm motion of the freestyle stroke can also cause shoulder pain. 

What causes swimmer’s shoulder?

1. Biceps impingement occurs during pull-through phase of freestyle swimming. If a swimmer's hand enters the water across the mid-line of her body, this will place the shoulder in a position of horizontal adduction. This results in impingement of the long head of the biceps against the anterior part of the coracoacromial arch.
2. Supraspinatus impingement occurs during the recovery phase of freestyle swimming.As a swimmer fatigues, it becomes more difficult for her to lift her arm out of the water, and the muscles of the rotator cuff become less efficient.When these muscles are not working properly, the supraspinatus muscle is mechanically impinged between the greater tuberosity of the humerus and the middle and posterior portions of the coracoacromial arch.

Activities that can cause impingement include:

• Improper swimming technique
• Overtraining
• Unilateral breathing
• Overuse of certain training equipment (hand paddles, kickboard, etc.)

What are the symptoms?

• Pain during or after swimming
• Pain that affects daily activities
• Pain that goes away after stopping swimming
• Pain that returns after swimming again
   

   

  Pain is often poorly localized (hard to find) and feels deep within the shoulder. On occasion, it can be associated with a particular position or phase of the stroke. Some describe their pain as being deep and localized to the posterior aspect of the shoulder, which is consistent with rotator cuff tendinitis, the most common underlying cause of pain in swimmer's shoulder.

  Swimming pushes the shoulder to its limits of strength and endurance.  This causes the rotator cuff muscles to fatigue before the “power muscles” do, allowing subluxation (partial dislocation) of the humeral head. This leads to decreased stroke efficiency and, possibly, injury.

   

  How do I prevent swimmer’s shoulder?

  1. Use proper stroke mechanics: During freestyle, the hand should enter the water with the small finger first and the palm facing inward. When the hand enters the water, it should not cross the middle of the body to avoid impingement.
  2. Avoid rapid increases in training distances or frequency of training.
  3. Stretch shoulder, chest and neck muscles will help to prevent a swimming posture that is conducive to impingement. Generally, swimmers have tight neck, chest and anterior shoulder muscles that cause them to assume a hunched over posture.
  4. Try a structured rotator cuff strengthening program during the off-season and a gradual increase in training at the beginning of the season. Thompson Health Sports Medicine is offering “Tuff Cuff,” a shoulder injury prevention program, at the Greater Canandaigua YMCA, on Thursdays, Feb. 23, March 8 and March 22. Keep reading for more information.
  5. Avoid rotator cuff fatigue through proper mechanics and conditioning
  6. Know the signs and symptoms of rotator cuff fatigue and tendinitis, and tell your physician, coach or athletic trainer if you have symptoms.

   

  How do I get better?  Pain relief, which is the first goal of treatment, involves resting the shoulder. In most cases, the athlete should stop or significantly decrease his or her swimming activities. An athletic trainer can help modify shoulder and activities to help avoid re-aggravation of the rotator cuff. Anti-inflammatory treatment in the form of regular icing and NSAIDs should also be instituted until the athlete is pain free.

   

  The addition of therapeutic modalities, such as ultrasound, phonophoresis, iontophoresis, or electrical stimulation can help further reduce pain and inflammation during the acute phase of injury.

   

  The second goal of treatment is to restore normal strength in the rotator cuff. Regaining strength can be accomplished with a supervised exercise program for the rotator cuff using relatively light weights (2-3 pounds, 5 pounds at maximum) and high repetitions (12-20 per set). These exercises can be performed on a daily basis or every other day.

   

  Working with an athletic trainer can be helpful, particularly one with expertise in treating shoulder injuries and swimmers, who can help the athlete transition from dry land exercises to swimming.

   

  When can I get back in the water? The athlete is allowed to return to swimming on a gradual basis once he is completely pain-free, has a full range of motion, and has normal strength of the rotator cuff, as compared to the opposite shoulder. Return to swimming should preferably occur under the guidance athletic trainer and swim coach.

   

  Educating athletes, parents, and coaches can go a long way toward successful rehabilitation and avoiding recurrent injuries. The role and importance of the rotator cuff in the swimmer's shoulder should be emphasized, and hence the importance of completing a shoulder rehabilitation program.

   

  What is Tuff Cuff, and how can it help me? Tuff Cuff is a shoulder injury prevention program offered by Thompson Health. Tuff Cuff teaches participants how to prevent injury by strengthening the smaller muscles of the rotator cuff and elbow joint, as well as how to maintain that strength during a sports season.

   

  Classes are offered at the Greater Canandaigua YMCA from 4 to 5 p.m. on Thursdays, Feb. 23, March 8 and March 22. Participants can attend any one of these sessions.

  Tuff Cuff is presented by Thompson Health Certified Athletic Trainer Jeremy Herniman. The cost to attend any class is $10 for YMCA members and $15 for non-members. Contact Thompson Health Sports Medicine at (585) 396-6050 for more information and register by calling the YMCA at (585) 394-6866.